Welfare state and Poverty in Flanders #10 Health

Poverty evolution in Flanders

10.     Health

In the previous chapters we saw that poverty in our society is a connection of many elements, often at the same time present with poor families, difficulties in the education, bad employment chances, a too small income, unhealthy housing, and difficult home situations. It is often also the pressure of those elements that undermines their health further and brings them in more awkward situations. Illness can reduce household savings, lower learning ability, reduce productivity, and lead to a diminished quality of life, thereby perpetuating or even increasing poverty.

Poverty barometre

A person’s health results largely from inherent factors, lifestyle, access to, and quality of healthcare. Social exclusion can be triggered by poor health, and may also reinforce health problems, for example, where the form of social exclusion results in barriers to healthcare. Reductions in infant mortality, changes in working/living conditions, education, and not least healthcare have all resulted in increased life expectancy, namely the mean number of years that a person (for example, a newborn child or a person aged 65) can expect to live if subjected throughout (the rest of) their life to current mortality conditions.
Long-standing diseases, frailty, mental disorders and physical disability tend to become more prevalent in older age, and the burden of these conditions may result in a lower quality of life for those who suffer from such conditions and may also impact upon those who care for them.

Social exclusion can result from poor health, where individuals who have physical or mental health problems cannot fully participate in society. In some cases, exclusion for some other reason (such as unemployment) may reinforce health problems. Poor health from birth, through working life to old age, and the way in which communities accept and help individuals overcome obstacles, can have important impacts on social inclusion.
Good health is essential to human welfare and to sustained economic and social development.

To achieve universal health coverage, countries need financing systems that enable people to use all types of health services – promotion, prevention, treatment and rehabilitation – without incurring financial hardship.

An unhealthy living situation, damp flat, housing without necessary hygienic facilities, no heating or necessary isolation, shall bring the person his health in danger. Indoor pollutants or mould cause asthma, allergies or respiratory diseases, which might be prevented by the use of proper building materials and construction. Poor design or construction of homes is the cause of many accidents.

Europe - Mortality rate for men of lung cancer...

Europe - Mortality rate for men of lung cancer - Image via Wikipedia

In Flanders everywhere is being built without respecting the necessary green.  The region is full of urban areas characterized by heavy traffic, pollution, noise, violence and social isolation for elderly people and young families. People in towns and cities experience increased rates of noncommunicable disease, injuries, and alcohol and substance abuse, with the poor typically exposed to the worst environments. In those areas not many affordable facilities are present for those without work or with a lower income. Though the Academies for music, word and dance offer classes in ballet and contemporary dance at a cheap rate, this is sometimes still too expensive for families with many children.

Active living benefits health at any age, but it is especially important to the healthy development of children and young people, and can make a substantial difference to the well-being of older people. On the contrary, physical inactivity is one of the leading risk factors for health and is estimated to attribute to one million deaths per year in the WHO European Region.
There is Bloso who tries to bring free fitness programs in parks and some villages and towns offer free playgrounds. But the population should be made more aware that regular exercise such as walking, cycling, or dancing not only makes them feel good, but that it has significant benefits for health. It not only reduces the risk of cardiovascular disease, diabetes and some cancers, helps control weight, and contributes to mental well-being. Taking part in physical activity also increases opportunities for making friends and feeling part of the community. The children of poorer families are often deprived of those advantages.

Not gaining enough money to pay for the rent and for food makes that a lot of people try to save money on food, but often they make the wrong choice of food and even spend lots of money at junk food, with the risks involved. The burden of disease associated with poor nutrition continues to grow. Poor diet, overweight and obesity contribute to a large proportion of noncommunicable diseases, including cardiovascular diseases and cancer, the two main killers in the Region. The excessive fat intake can be seen by lower income families, who also have a low fruit and vegetable intake. In those families with several problems we can find increasing problems of eating and sleeping disorders, all of which not only shorten life expectancy, but also harm the quality of life.

But also dangerous work circumstances and an unbalanced feeding will entail in many cases health problems. From fear and because of their financial situation, they shall not be eager to go to visit their general practitioner or a dentist. Postponing a necessary visit to the doctor shall bring them more at risk to have such a bad condition it is even going to cost more to remedy it.

For many households, relatively small payments can become their steady drip of medical bills forcing them into poverty. Certainly when they are chronically ill or are disabled. Not only do out-of-pocket payments deter people from using health services and cause financial stress, they also cause inefficiency and inequity in the way resources are used. They encourage overuse by people who can pay and underuse by those who cannot.[1]

Some people will face financial barriers to access even if direct payments are eliminated; transport and accommodation costs to obtain treatment might still prove prohibitive. The government must consider options, including providing enough affordable public transport and conditional cash transfers, for reducing these barriers.

In Belgium and the Netherlands, the annual mortality rate amounts to 2 times more in the lowest educated group in comparison with the most trained. The difference between these groups concerning life expectation amounts to 15 year![2]

In Belgium the life expectation of a 25 year old man without diploma is 5.5 year lower than these of a 25-year old with a diploma higher education of the long type. A second establishment is that men of 25 year have an average life expectation of 49.6 years of which they are on average 37.5 years in good health. An unqualified 25-year old man lives only an average of 28.1 years in good health. The data bank also observes a difference of lifestyle between the higher and the lower incoming classes: * 18.5% of the higher incoming class smokes daily, opposite 27.9% of the lowest incoming classes * 76.6% of the higher incomes are weekly physical asset, opposite 59.2% of the lowest incoming class.[3]

Approximately 10% of the Belgian population lives in a family where in the course of the past year health care was postponed or scraped because of financial reasons. In 2009 2% of them at least once a year preceding a visit to the doctor or dentist have had to postpone because of financial reasons. This corresponds to approximately 110,000 people. Moreover there is also yet a very large risk group that now just sees fit to bring their expenses in accordance with their budget. When the percentage for basic needs expenses remains rising this can have pernicious consequences in the near future for them.[4]

The living conditions and the exclusion make it that men constantly live under stress, and that there is not enough distraction for them and for their children or no holidays, that take away the tensions which creep up in the house keeping. Under these miserable circumstances there is felt an experience of life of continual exclusion and marginality. Life in misery is life in powerlessness, fear, in indignity. One is nobody. That is injustice.

We should remove financial barriers to access and reduce financial risks of illness and make better use of the available resources, working more preventive then curative.

Read also: Armoede en gezondheid: voorstellen van oplossingen, Lieven Annemans (pdf)

Een analyse van de Armoede in Vlaanderen door Marcus Ampe - Poverty in Flanders, an ananlyse by Marcus Ampe


[1] The more that countries rely on direct payments, such as user-fees, to fund their health systems, the more difficult is it to meet the UN objectives of the World Health Assembly to provide all people with access to needed health services (including prevention, promotion, treatment and rehabilitation) of sufficient quality to be effective;  ensure that the use of these services does not expose the user to financial hardship.

[3] Vranken, J., ea. 2001 p256

[4] Armoede schaadt de gezondheid; KUL, Thomasgenootschap

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  • UN: Deaths up from cancer, diabetes, heart disease (ctv.ca)
    Nearly two-thirds of deaths in the world are caused by noncommunicable diseases such as cancer, diabetes and heart and lung disease which are rapidly increasing at a cost to the global economy of trillions of dollars, according to UN estimates and preliminary results of a new study.
    By 2030 noncommunicable diseases are expected to cause five times as many deaths as communicable diseases worldwide.”No health problem in the history of the world has ever gone so hidden, misunderstood and under-recorded,” John Seffrin, CEO of the American Cancer Society, said.Seffrin said “it is the poorest people that suffer the most” because they can’t afford early detection and quality care and must deal with overburdened and poorly equipped health care systems.Professor David Bloom of the Harvard School of Public Health, who is leading a project to estimate the global economic burden of noncommunicable diseases, said preliminary results indicate that the substantial economic burden caused by these diseases today “will evolve into a staggering economic burden over the next two decades” that could have a huge impact on economic development and fighting poverty.Both the human and economic burden of noncommunicable diseases can be contained, Bloom said, by devoting resources directly or indirectly to prevention, screening and treatment throughout the world.
  • Welfare state and Poverty in Flanders #6 Transport factor of immobilising financial growth (marcusampe.wordpress.com)
  • Welfare state and Poverty in Flanders #8 Work (marcusampe.wordpress.com)

About Marcus Ampe

Retired dancer, choreographer, choreologist Founder of the Dance impresario office and archive: Danscontact-Dansarchief plus the Association for Bible scholars, the Lifestyle magazines "Stepping Toes" and "From Guestwriters" and creator of the site "Messiah for all". - Gepensioneerd danser, choreograaf, choreoloog. Stichter van Danscontact-Dansarchief plus van de Vereniging voor Bijbelvorsers, de Lifestyle magazines "Stepping Toes" en "From Guestwriters" en maker van de site "Messiah for all".
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6 Responses to Welfare state and Poverty in Flanders #10 Health

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